La réduction de facteurs de risque de chronicité et le retour au travail

L’objectif de cette recherche était d’examiner le degré avec lequel la réduction des facteurs de risques psychosociaux était associée au retour au travail. Cette recherche a été effectuée dans le contexte d’un programme de réadaptation pour les travailleurs ayant subi une blessure au dos. Les participants étaient 116 (68 hommes, 48 femmes) clients de la Commission des accidents du travail de la Nouvelle-Écosse ayant demandé une indemnisation pour accident de travail. Les participants étaient orientés vers une intervention cognitivo-comportementale, donc le but était de réduire les obstacles psychologiques au progrès en réadaptation. Les facteurs psychologiques ciblés par le programme étaient les pensées catastrophiques, la crainte du mouvement, les croyances concernant l’incapacité et la dépression. Dans cet échantillon, 56 % des participants ont retourné au travail dans les quatre semaines suivant la fin du traitement. Des analyses de variance à mesures répétées ont révélé des diminutions significatives dans la douleur, la dépression, les pensées catastrophiques, les croyances concernant l’incapacité, et la peur du mouvement. Des analyses univariées ont indiqué que la réduction de tous les facteurs de risque était associée à une plus haute probabilité de retour au travail. Une analyse de régression logistique a révélé que la durée d’absence du travail et la réduction des pensées catastrophiques ont contribué uniquement à la prédiction du retour au travail. Les résultats de cette étude offrent des preuves préliminaires selon lesquelles les interventions qui visent spécifiquement à réduire les facteurs de risques psychosociaux reliés à la chronicité ont un impact positif sur la probabilité de retour au travail.The purpose of the present study was to examine the degree to which psychosocial risk factor reduction was associated with the return to work. This study was carried out in the context of a rehabilitation program for workers who had suffered a back injury. The participants were 116 Nova Scotia WCB claimants (68 men, 48 women) who had made a claim for an industrial accident. The participants were oriented towards a cognitive behavioral intervention whose purpose was to reduce psychological obstacles to rehabilitation. The psychosocial risk factors targeted by the program included pain catastrophizing, fear of movement, beliefs about disability, and depression. In this sample, 56 % of the participants returned to work within four weeks of treatment termination. Pre- to post-treatment comparisons revealed significant reductions in pain, depression, catastrophizing, perceived disability, and fear of movement. Univariate analyses revealed that reductions in all risk factors were associated with a higher probability of a return to work. Logistic regression revealed that only the duration of work disability and the reduction in pain catastrophizing contributed solely to the prediction of a return to work. The results of the present study provide preliminary evidence that the reduction of psychosocial risk factors related to chronicity may have a positive impact on the probability of returning to work.El objetivo de esta investigación era de examinar hasta qué punto se asocia la reducción de factores de riesgos psicosociales con la vuelta al trabajo. Se ha efectuado esta investigación en el contexto de un programa de rehabilitación para trabajadores que han sufrido de una herida en la espalda. Los participantes eran 116 (68 hombres y 48 mujeres) clientes de la Comisión de los accidentes en el trabajo de Nueva Escocia que habían pedido una indemnización por accidente laboral. Los participantes eran orientados hacia una intervención cognitivo-conductual cuya finalidad era de reducir los obstáculos psicológicos a su rehabilitación. Los factores psicológicos focalizados en este programa eran los pensamientos catastróficos, el miedo del movimiento, las creencias a propósito de la invalidez y la depresión. En estea muestra, 56 % de los participantes volvieron al trabajo en las quatro semanas siguiente el fín del tratamiento. Análisis de varianza con mediciones repetidas han revelado diminuciones significativas del dolor, la depresión, la catastrofización, las creencias a propósito de la invalidez y el miedo del movimiento. Análisis univariados indicaron que la reducción de todos los factores de riesgos se relacionan con una probabilidad más grande de la vuelta al trabajo. Análisis de regresión logísticos han revelado que la duración de ausencia al trabajo y la reducción de la catastrofización han contribuido solamente a la predicción de la vuelta al trabajo. Los resultados de este estudio demuestran mediante pruebas preliminarias que la reducción de los factores de riesgos psicosociales vinculados a la cronicidad tienen un impacto positivo sobre la probabilidad de la vuelta al trabajo

Stage of chronicity and treatment response in patients with musculoskeletal injuries and concurrent symptoms of depression

Abstract The present study examined the relation between stage of chronicity and treatment response in patients with work-related musculoskeletal conditions and concurrent depressive symptoms. Also of interest was the role of reductions in pain severity, catastrophic thinking and fear of movement/re-injury as mediators of the relation between chronicity and treatment response. A sample of 80 individuals (38 women, 42 men) with a disabling musculoskeletal pain condition and concurrent depressive symptoms participated in the research. Individuals with work absence of less than 6 months (range 12-26 weeks) were classified as early chronic (N = 40), and individuals with work absence greater than 6 months (range 27-52 weeks) were classified as chronic. Both groups were matched on sex, age (±2 years) and severity of depressive symptoms. All participants were enrolled in a 10-week community-based disability management intervention. The early chronic group showed significantly greater reduction in depressive symptoms, and pain symptoms, than the chronic group. Regression analyses revealed that pain reduction, but not catastrophic thinking or fear of movement/ re-injury, mediated the relation between chronicity and improvement in depressive symptoms. The results highlight the importance of early detection and treatment of depressive symptoms, given that treatment response decreases over time. The results also suggest that reductions in depressive symptoms might be a precondition to the effective reduction of pain symptoms in this population. Discussion addresses the factors that might contribute to treatment resistance as the period of disability extends over time.

A computer program for the generalized chi-square analysis of categorical data using weighted least squares (GENCAT)

GENCAT is a computer program which implements an extremely general methodology for the analysis of multivariate categorical data. This approach essentially involves the construction of test statistics for hypotheses involving functions of the observed proportions which are directed at the relationships under investigation and the estimation of corresponding model parameters via weighted least squares computations. Any compounded function of the observed proportions which can be formulated as a sequence of the following transformations of the data vector -- linear, logarithmic, exponential, or the addition of a vector of constants -- can be analyzed within this general framework. This algorithm produces minimum modified chi-square statistics which are obtained by partitioning the sums of squares as in ANOVA. The input data can be either: (a) frequencies from a multidimensional contingency table; (b) a vector of functions with its estimated covariance matrix; and (c) raw data in the form of integer-valued variables associated with each subject. The input format is completely flexible for the data as well as for the matrices.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/21627/1/0000006.pd

Subchondral pre-solidified chitosan/blood implants elicit reproducible early osteochondral wound-repair responses including neutrophil and stromal cell chemotaxis, bone resorption and repair, enhanced repair tissue integration and delayed matrix deposition

Background: In this study we evaluated a novel approach to guide the bone marrow-driven articular cartilage repair response in skeletally aged rabbits. We hypothesized that dispersed chitosan particles implanted close to the bone marrow degrade in situ in a molecular mass-dependent manner, and attract more stromal cells to the site in aged rabbits compared to the blood clot in untreated controls. Methods: Three microdrill hole defects, 1.4 mm diameter and 2 mm deep, were created in both knee trochlea of 30 month-old New Zealand White rabbits. Each of 3 isotonic chitosan solutions (150, 40, 10 kDa, 80% degree of deaceylation, with fluorescent chitosan tracer) was mixed with autologous rabbit whole blood, clotted with Tissue Factor to form cylindrical implants, and press-fit in drill holes in the left knee while contralateral holes received Tissue Factor or no treatment. At day 1 or day 21 post-operative, defects were analyzed by micro-computed tomography, histomorphometry and stereology for bone and soft tissue repair. Results: All 3 implants filled the top of defects at day 1 and were partly degraded in situ at 21 days post-operative. All implants attracted neutrophils, osteoclasts and abundant bone marrow-derived stromal cells, stimulated bone resorption followed by new woven bone repair (bone remodeling) and promoted repair tissue-bone integration. 150 kDa chitosan implant was less degraded, and elicited more apoptotic neutrophils and bone resorption than 10 kDa chitosan implant. Drilled controls elicited a poorly integrated fibrous or fibrocartilaginous tissue. Conclusions: Pre-solidified implants elicit stromal cells and vigorous bone plate remodeling through a phase involving neutrophil chemotaxis. Pre-solidified chitosan implants are tunable by molecular mass, and could be beneficial for augmented marrow stimulation therapy if the recruited stromal cells can progress to bone and cartilage repair

The young athlete with physical challenges

Médecine du sport pour jeunes sportifs handicapés. Systèmes de classification en fonction de la sévérité du handicap. Problèmes spécifiques du contrôle médical de l'aptitude à la pratique sportive. Pathologies et traumatismes physiques des athlètes en fauteuil roulant, des athlètes amputés, des athlètes déficients visuels ou auditifs

The young athlete with physical challenges

Médecine du sport pour jeunes sportifs handicapés. Systèmes de classification en fonction de la sévérité du handicap. Problèmes spécifiques du contrôle médical de l'aptitude à la pratique sportive. Pathologies et traumatismes physiques des athlètes en fauteuil roulant, des athlètes amputés, des athlètes déficients visuels ou auditifs